title: Acute total hip replacement for acetabular fractures: a systematic review of the literature.
abstract: BACKGROUND
  Immediate total hip replacement (THR) in patients with acetabular fractures is controversial because of concerns about high complication rates. The current article is a systematic review of the literature on the use of acute THR for the treatment of acetabular fractures.
  
  
  METHODS
  This systematic review included studies published in English between 1992 and 2012 of subjects with acetabular fracture undergoing immediate THR. Outcomes of interest included indications; clinical assessment, including walking ability; comparison with control group; associated procedures, and rate of complications, such as loosening or revision surgery.
  
  
  RESULTS
  This review identified six studies, of which only one included a control group. Acute THR was associated with satisfying outcomes with regard to clinical assessment and walking ability. The comparative study assessed the difference between acute THR and delayed THR in acetabular fractures: improved outcomes were observed in the delayed THR group, although the differences between the two groups were not statistically significant.
  
  
  CONCLUSIONS
  According to data reported in the literature, acute primary THR can be successful in patients with poor bone quality, combined acetabular and femoral neck fractures, or pathological fractures and concurrent osteoarthritis of the hip. Relative indications include old age, delayed presentation, substantial medical comorbidities, and pathologic obesity. Clinical outcomes with acute THR were similar to those with delayed THR. Although the results reported in the six studies reviewed here were satisfying overall, there is limited evidence in this area in the existing literature and future prospective investigations are required.
  
  
  CONCLUSIONS
  Data reported in the literature indicate that immediate THR can be successful in appropriately selected elderly patients or patients with extensive osteoporosis, combined acetabular and femoral neck fractures or pathological fractures. There is currently a limited evidence base for THR in patients with acetabular fractures; therefore, physicians' practice and expertise are the most useful tools in clinical practice.
authors.affiliation: U.O.S.D. Servizio di Traumatologia d'Urgenza, Istituto Ortopedico G. Pini, Milano, Italy. Electronic address: umbertogiovanni.debellis@gpini.it.
authors.forename: Umberto Giovanni
authors.initials: UG
authors.lastname: De Bellis
authors.affiliation: Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Legnani
authors.affiliation: S.C. Chirurgia Ortopedica Riparativa e Risk Management, Istituto Ortopedico G. Pini, Milano, Italy.
authors.forename: Giorgio Maria
authors.initials: GM
authors.lastname: Calori
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D010024:Osteoporosis / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Acetabular fracture; Acute total hip replacement; Immediate total hip replacement; Walking ability; Weight-bearing